Healthcare Provider Details

I. General information

NPI: 1104823426
Provider Name (Legal Business Name): THOMAS M PIEKLO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 GENESEE ST
HORNELL NY
14843-1614
US

IV. Provider business mailing address

36 GENESEE ST
HORNELL NY
14843-1614
US

V. Phone/Fax

Practice location:
  • Phone: 607-324-5141
  • Fax: 607-324-5141
Mailing address:
  • Phone: 607-324-5141
  • Fax: 607-324-5141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN004313-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: